Surgical management of symptomatic intrasellar arachnoid cysts--two case reports

Two patients with symptomatic intrasellar arachnoid cyst were successfully treated. A 67-year-old female with a cyst 20 mm in diameter developed headache and visual disturbance. She was treated by transsphenoidal surgery. A 59-year-old male with a cyst measuring 35 x 30 x 50 mm causing headache, visual disturbance, and deterioration of consciousness was managed by wide resection of the cyst wall via craniotomy. Postoperative courses in both patients were uneventful. Transsphenoidal surgery may be suitable for small to medium-sized cysts, although tight packing of the sella is mandatory to prevent leakage of cerebrospinal fluid. However, craniotomy is recommended for large intra- and suprasellar arachnoid cysts to avoid this complication, and to achieve sufficient communication between the cyst and the subarachnoid cistern.